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Leprosy Outbreak in United States Only a 'Matter of Time,' One Physician Argues

Certain populations in the United States are at risk for a resurgence of leprosy, or Hansen’s disease, according to a New York University physician who penned a public health warning in The Hill this week.

The US Centers for Disease Control and Prevention (CDC) reports there are only about 150 to 250 cases of leprosy reported in the United States in a given year, but between 2 and 3 million people are living with leprosy-related disabilities globally. It is more common in Central and South America, which see a combined average of 20,000 new cases per year.

Even though leprosy is not widespread in the United States, the current landscape in some cities, such as Los Angeles, is creating the perfect environment for so-called “ancient” diseases to flourish. Caused by the slow-growing bacteria Mycobacterium leprae, leprosy spreads more easily in close, unsanitary quarters.

Marc K. Siegel, MD, professor of medicine and medical director at Doctor Radio at NYU Langone Health, is sounding the alarm for his fellow physicians about the rise in diseases not seen since the Middle Ages, such as leprosy, and the conditions that contribute to the spread of these infections.

“…[I]t seems only a matter of time before leprosy could take hold among the homeless population in an area such as Los Angeles County, with close to 60,000 homeless people and 75% of those lacking even temporary shelter or adequate hygiene and medical treatment,” Siegel wrote in The Hill. “All of those factors make a perfect cauldron for a contagious disease that is transmitted by nasal droplets and respiratory secretions with close repeated contact.”

Leprosy is easily treatable with antibiotics when detected early; the problem is that early detection may be a hurdle for individuals experiencing homelessness, as they are not likely to be receiving regular medical care. And when left untreated, leprosy can lead to serious complications, including peripheral nerve damage, skin lesions, and even blindness.

“I am much more concerned about the permanent disabilities that come with leprosy—given that 2 million to 3 million people are affected worldwide—than I am with the associated stigma,” Siegel wrote. “Nevertheless, leprosy appearing among the homeless in LA is a sure recipe for instant public panic.”

In an interview with Contagion® earlier this year, Drew Pinsky, MD, delivered a similar warning to his fellow health care professionals, specifically calling out the unsanitary conditions on Los Angeles’ streets that are exacerbated by the large homeless population there.

“Now we have tuberculosis, measles, typhus…I started looking at what usually comes on the heels of typhus in this area, and that’s Yersinia (bubonic plague),” Pinsky, an internist and globally recognized addiction medicine specialist, said. “It has been documented on the squirrels, and it’s just a matter of time before it gets on the rats, then our pets, and then on us.”
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